title: Background changing patterns of neonatal fungal sepsis in a developing country.
abstract: BACKGROUND
  Candida albicans is the predominant isolate in many neonatal fungal bloodstream infections (BSIs), so fluconazole is used as empiric antifungal therapy.
  
  
  OBJECTIVE
  To determine the predominant organisms, antifungal sensitivity patterns, clinical and demographic risk factors and crude mortality rate in neonatal fungal BSI cases.
  
  
  METHODS
  This is a review of all neonatal fungal BSI cases between January 2007 and December 2011.
  
  
  RESULTS
  Fifty-nine patients were included in the study. Candida parapsilosis (54.2%) was isolated in majority of the cases, followed by C. albicans (27.1%). Fluconazole resistance was present in 16 of 32 cases of C. parapsilosis versus 1 of 16 cases of C. albicans (P = 0.003). Mortality rate was 45.8%. Surgical problems were present in 55.9%. Death was significantly associated with lower birth weight (P = 0.046) and necrotizing enterocolitis (P = 0.034).
  
  
  CONCLUSIONS
  The increase in neonatal fungal BSI and resistant organisms highlights the need to review use of routine empiric fluconazole and to implement preventive measures.
authors.affiliation: Department of Paediatrics and Child Health, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Daynia E
authors.initials: DE
authors.lastname: Ballot
authors.forename: Noma
authors.initials: N
authors.lastname: Bosman
authors.forename: Trusha
authors.initials: T
authors.lastname: Nana
authors.forename: Tanisha
authors.initials: T
authors.lastname: Ramdin
authors.forename: Peter A
authors.initials: PA
authors.lastname: Cooper
mesh_terms: D000935:Antifungal Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001724:Birth Weight; D002175:Candida / Q000145:classification / Q000187:drug effects / Q000302:isolation & purification*; D058387:Candidemia / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D002177:Candidiasis / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality; D025141:Drug Resistance, Fungal; D005260:Female; D015725:Fluconazole / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D008297:Male; D008826:Microbial Sensitivity Tests; D011743:Pyrimidines / Q000494:pharmacology / Q000627:therapeutic use; D012307:Risk Factors; D012959:Socioeconomic Factors; D013019:South Africa / Q000453:epidemiology; D016896:Treatment Outcome; D014230:Triazoles / Q000494:pharmacology / Q000627:therapeutic use; D065819:Voriconazole
chemical_list: D000935:Antifungal Agents; D011743:Pyrimidines; D014230:Triazoles; D015725:Fluconazole; D065819:Voriconazole
keywords: Candida; fungal bloodstream infections; fungal sepsis; neonates